Markowitz L E, Hynes N A, de la Cruz P, Campos E, Barbaree J M, Plikaytis B D, Mosier D, Kaufmann A F
JAMA. 1985;254(20):2922-5. doi: 10.1001/jama.254.20.2922.
Between June 1 and July 15, 1984, twenty persons with glandular tularemia were identified on the Lower Brule and Crow Creek Indian reservations in South Dakota. The median age of the patients was 6 years (range, 2 to 20 years). The clinical illness was mild, consisting of fever, headache, and lymphadenopathy. All lymphadenopathy was in the head and neck area. Dermacentor variabilis ticks were identified as the vector. Although the mild clinical illness suggested Francisella tularensis, type B, was the agent, both type A and type B strains of F tularensis were isolated from ticks collected from dogs in the area. Tularemia is generally thought to be a severe systemic illness in North America. This outbreak illustrates that it can be a mild disease and that both type A and type B strains can be tick-borne and coexist in the same ecosystem.
1984年6月1日至7月15日期间，在南达科他州的下布鲁尔和克劳克里克印第安人保留地发现了20例腺型兔热病患者。患者的年龄中位数为6岁（范围为2至20岁）。临床症状较轻，包括发热、头痛和淋巴结病。所有淋巴结病均位于头颈部区域。变异革蜱被确定为传播媒介。尽管轻微的临床症状提示病原体为B型土拉弗朗西斯菌，但从该地区狗身上采集的蜱中分离出了A型和B型土拉弗朗西斯菌菌株。在北美，兔热病通常被认为是一种严重的全身性疾病。此次疫情表明，它也可以是一种轻症疾病，且A型和B型菌株都可通过蜱传播并共存于同一生态系统中。
